Result(s):
At the time of evaluation, 9,387 men with a mean age of 38 years had semen data available. Of these men, 44% had at least one medical diagnosis unrelated to infertility. When stratifying the cohort by the Charlson comorbidity index (CCI), differences in all measured semen parameters were identified. Men with a higher CCI had lower semen volume, concentration, motility, total sperm count, and morphology scores. In addition, men with diseases of the endocrine, circulatory, genitourinary, and skin diseases all showed significantly higher rates of semen abnormalities. Upon closer examination of diseases of the circulatory system, men with hypertensive disease, peripheral vascular and cerebrovascular disease, and nonischemic heart disease all displayed higher rates of semen abnormalities.

Conclusion(s):
The current report identified a relationship between medical comorbidites and male semen production. Although genetics help guide a man’s sperm production, his current condition and health play an important role.

This article demonstrates the potential global impact of overall health upon fertility status. Given the obesity epidemic that is prevalent in our adolescents and young adults, this is going to be a significant issue in their child bearing years. This should serve as a wake up call to the pediatricians and primary care providers. We also need to be involved in educating our colleagues and patients on the ramifications of poor overall health.

This also brings up a huge challenge in the treatment of these chronic diseases. Should we as practitioners just throw medications to control HTN, DM, HLD, etc. which is the easier pathway in this day and age of capitation and the ACA. OR should we encourage lifestyle modification, which takes much more effort on the part of the patient, but may bring on much more lasting change and improvement in the long run?

ranjithrama

Mike Eisenberg adds to the series of studies that indicate an association between men with abnormal semen parameters and comorbidity and mortality. How should urologists counsel an infertile man with abnormal semen parameters beyond the fertility evaluation? Can we make a case for checking BP / HbA1c / fasting lipid panels in men with infertility?

wbgrant

Low 25-hydroxyvitamin D concentrations may explain the link between semen production and medical comorbidity

The recent paper by Eisenberg and colleagues found that poor
semen quality and infertility were associated with increased risk of endocrine
disease, nutritional and metabolic disorders, genitourinary diseases, and skin
disorders, but not with several other diseases (1). They noted that diabetes
mellitus impacts male fertility through ejaculatory and erectile impairments,
and that men with infertility have reduced circulating testosterone levels
compared to fertile men. They did not provide a comprehensive hypothesis to
explain their findings. I would like to propose that low 25-hydroxyvitamin D
[25(OH)D] concentrations may explain their findings and related ones discussed
in the paper.

There are several different ways to study the link between
vitamin D and health outcomes. At present, observational studies based on
25(OH)D concentrations have provided the largest set of supportive findings
(2). Results from randomized controlled trials (RCTs) have been largely
inconclusive due the fact that most such trials were poorly designed, often
enrolling people with 25(OH)D concentrations too high to find an effect of the
low vitamin D doses often used (3). Thus, this letter will use examples
primarily from observational studies. In support, it is noted that mechanisms
have been identified to explain most of the vitamin D-health outcome relations.

Here are the findings from the literature. In terms of male fertility, low 25(OH)D concentrations were associated with poor semen quality in infertile men (4). A review found vitamin D signalling has a positive effect on semen quality (5). Low 25(OH)D
concentrations are also associated with erectile dysfunction related to endothelial factors (6, 7).

If blood samples are available from some of the men studied in Ref. 1, 25(OH)D concentrations could be measured to evaluate the vitamin D-infertility-medical comorbidity hypothesis. If not, an additional study could easily be mounted.

Meanwhile, men who are infertile could be advised to have their 25(OH)D concentration measured and, if low, raise it by ultraviolet-B exposure or vitamin D supplements to about 30-60 ng/mL (17).

The etiology for the association between a man’s fertility and his overall health is uncertain. Genetic, hormonal, in utero, and lifestyle factors have all been proposed. It is likely that all contribute to some extent. Dr. Grant makes a compelling argument that vitamin D may provide another link in the causal pathway.

Jason Kovac

It is interesting to note that numerous male multi-vitamins have different levels of vitamin D in them. Indeed, some have none. Should we be advocating for patients using those products that contain higher levels of vitamin D?

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